Current Controversies in Sepsis Management

Stephanie R. Moss, MD; Hallie C. Prescott, MD, MSc

Disclosures

Semin Respir Crit Care Med. 2019;40(5):594-603. 

In This Article

Abstract and Introduction

Abstract

The overarching goals of early sepsis management include early recognition, appropriate antibiotic therapy and source control, maintenance of hemodynamic stability, and supportive care of organ dysfunction. Despite increasing awareness of the global burden of sepsis, and general agreement on the goals of management, there is ongoing controversy regarding the implementation of specific treatment strategies to optimize patient outcomes. This article will address five current points of controversy in the management of sepsis and septic shock. These include optimal timing of antibiotics in patients with potential sepsis, the role of glucocorticoids in septic shock, vitamin C as a novel therapy for sepsis, the ideal intravenous fluid for resuscitation, and the optimal balance of fluid resuscitation and vasopressor administration in septic shock. For each of these topics, we review relevant literature, discuss areas of controversy, and present our current approach to management.

Introduction

Sepsis is a well-established cause of morbidity and mortality worldwide, resulting in an estimated 19 million hospitalizations and 5.8 million deaths annually.[1] Beyond the initial hospitalization, survivors of sepsis are at increased risk for new morbidity, re-hospitalization, and death in the months and years afterwards.[2–4]

Despite increasing awareness of the magnitude of the problem,[5] new targeted therapies for sepsis have been limited.[6] Therefore, management has focused on early recognition, expedient treatment of the underlying infection,[7] and optimization of resuscitation.[6] Despite broad acceptance of these general principles, however, there is controversy about how best to implement them. In the article we discuss current evidence and debate regarding antibiotic timing, adjunctive corticosteroids, vitamin C, type of crystalloid, and early resuscitation strategies.

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